Acne Vulgaris Prevalence of 35 90 in adolescents

Acne Vulgaris ØPrevalence of 35 -90% in adolescents

Acne Vulgaris ØPrevalence of 35 -90% in adolescents ØPathogenesis

Acne Vulgaris ØPrevalence of 35 -90% in adolescents ØPathogenesis • Follicular hyperkeratosis • Increase sebum production • Propionibacterium acnes within the follicle • Inflammation

Grading of Acne Vulgaris ØMild acne (Grade I) : predominance of comedones • Comedone < 30 • Papule < 10 • No scaring

Grading of Acne Vulgaris ØMild acne (Grade I) : predominance of comedones • Comedone < 30 • Papule < 10 • No scaring ØModerate acne (grade II) predominance of papules • Comedone any number • Papule > 10 • Nodule < 3 • Scaring ±

Grading of Acne Vulgaris Ø Mild acne (Grade I) : predominance of comedones • Comedone < 30 • Papule < 10 • No scaring Ø Moderate acne (grade II) predominance of papules • • Comedone any number Papule > 10 Nodule < 3 Scaring ± ØSevere acne (grade III) many nodules • Comedone any number • Papule any number • Nodule/cyst > 3 • Scaring +

Acne Vulgaris Treatment ØTopical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1%

Acne Vulgaris Treatment Topical Retinoids ØNormalization of follicular keratinization and corneocyte cohesion ØCause local irritation ØSusceptibility to sunburn ØTretinoine is photolabile so night application is recommended ØAdapalen is less irritant and light-stable

Acne Vulgaris Treatments Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% ØTopical antibiotics • Benzoyl peroxide (2. 5 -10%)

Acne Vulgaris Treatments Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% ØTopical antibiotics • Benzoyl peroxide (2. 5 -10%) • Clindamycine (1 -2%)

Acne Vulgaris Treatments Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% ØTopical antibiotics • Benzoyl peroxide (2. 5 -10%) • Clindamycine (1 -2%) • Erythromycin (2 -4%)

Acne Vulgaris Treatments Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% ØTopical antibiotics • Benzoyl peroxide (2. 5 -10%) • Clindamycine (1 -2%) • Erythromycin (2 -4%) • Azelaic acid (20%)

Acne Vulgaris Treatments Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% ØTopical antibiotics • Benzoyl peroxide (2. 5 -10%) • Clindamycine (1 -2%) • Erythromycin (2 -4%) • Azelaic acid (20%) • Dapson (5%)

Acne Vulgaris Treatments Topical antibiotics ØIn contrast to topical AB microbial resistance to BPO not reported ØAzelaic acid has comedolytic properties and help to lighten PIP

Acne Vulgaris Treatment Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% Ø Topical antibiotics • • • Benzoyl peroxide (2. 5 -10%) Clindamycine (1 -2%) Erythromycin (2 -4%) Azelaic acid (20%) Dapson (5%) ØOral antibiotics • Tetracyclines (doxycycline and minocycline) • Macrolides (erythromycin and azithromycin)

Acne Vulgaris Treatment Oral antibiotics ØMechanism of action • Suppression of the growth of P. acnes • Intrinsic anti-inflammatory properties

Acne Vulgaris Treatment Ø Topical retinoids • Tretinoin (0. 025% to 0. 1%) • Isotretinoin (0. 05%) • Adapalen 0. 1% Ø Topical antibiotics • • • Benzoyl peroxide (2. 5 -10%) Clindamycine (1 -2%) Erythromycin (2 -4%) Azelaic acid (20%) Dapson (5%) Ø Oral antibiotics • Tetracyclines (doxycycline and minocycline) • macrolides (erythromycin and azithromycin) ØIsotretinoin

Acne Vulgaris Treatment Isotretinoin ØIndications

Acne Vulgaris Treatment Isotretinoin ØIndications • Significant acne that is unresponsive to therapy

Acne Vulgaris Treatment Isotretinoin ØIndications • Significant acne that is unresponsive to therapy • Scarring

Acne Vulgaris Treatment Isotretinoin ØIndications • Significant acne that is unresponsive to therapy • Scarring • Gram-negative folliculitis

Acne Vulgaris Treatment Isotretinoin ØIndications • Significant acne that is unresponsive to therapy • Scarring • Gram-negative folliculitis • Pyoderma faciale

Acne Vulgaris Treatment Isotretinoin ØIndications • Significant acne that is unresponsive to therapy • Scarring • Gram-negative folliculitis • Pyoderma faciale • Acne fulminans

Acne Vulgaris Treatment Isotretinoin Ø Indications • • • Significant acne that is unresponsive to therapy Scarring Gram-negative folliculitis Pyoderma faciale Acne fulminans Ø 0. 5 – 1 mg/kg/day often with lower dose during the first month

Acne Vulgaris Treatment Isotretinoin Ø Indications • • • Significant acne that is unresponsive to therapy Scarring Gram-negative folliculitis Pyoderma faciale Acne fulminans Ø 0. 5 – 1 mg/kg/day often with lower dose during the first month ØCumulative dose of 120 mg/kg

Acne Vulgaris Treatment Isotretinoin Ø Indications • • • Significant acne that is unresponsive to therapy Scarring Gram-negative folliculitis Pyoderma faciale Acne fulminans Ø 0. 5 – 1 mg/kg/day often with lower dose during the first month ØCumulative dose of 120 mg/kg ØCommon adverse effects

Acne Vulgaris Treatment Isotretinoin Ø Indications • • • Significant acne that is unresponsive to therapy Scarring Gram-negative folliculitis Pyoderma faciale Acne fulminans Ø 0. 5 – 1 mg/kg/day often with lower dose during the first month ØCumulative dose of 120 mg/kg ØCommon adverse effects • Dryness of mucosal surface

Acne Vulgaris Treatment Isotretinoin Ø Indications • • • Significant acne that is unresponsive to therapy Scarring Gram-negative folliculitis Pyoderma faciale Acne fulminans Ø 0. 5 – 1 mg/kg/day often with lower dose during the first month ØCumulative dose of 120 mg/kg ØCommon adverse effects • Dryness of mucosal surface • Xerosis and skin fragility

Acne Vulgaris Treatment ØMild acne

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB ØModerate acne

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB ØModerate acne • Oral AB + topical retinoids ± BPO/topical AB

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB ØModerate acne • Oral AB + topical retinoids ± BPO/topical AB ØSevere acne

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB ØModerate acne • Oral AB + topical retinoids ± BPO/topical AB ØSevere acne • Oral isotretinoin ± oral CS

Acne Vulgaris Treatment ØMild acne • Comedonal: topical retinoids • Papular/pustular: topical retinoids + topical AB ØModerate acne • Oral AB + topical retinoids ± BPO/topical AB ØSevere acne • Oral isotretinoin ± oral CS • Refer to dermatologist

Acne Vulgaris Treatment ØRefer to dermatologist • Severe acne • Any scar • Do not response to topical treatment and oral antibiotic therapy • Acne excoriee